APOLOGIES FOR PAST WRONGS AND GRIEVANCES

PREAMBLE: Disputes over past conflicts often overshadow present and future relations of peoples and states for generations.

Contemporary political debates concerning recent and past conflicts are extensive in number, demonstrating that perceptions matter in today’s politics, and that conflicts do not necessarily resolve by ending a war or signing a treaty.

Negotiating an agreement can send a positive signal to the parties involved that they are willing to end the injustices and violence, but the emotional issues created can set the stage for resumption of hostilities even after a negotiated settlement is reached. Thus, in order for a conflict to be truly resolved there needs to be a lengthy process of reconciliation aimed at eradicating the emotional barriers between those involved and resuming trust between the victims and perpetrators.

In this blog we offer an overview of the underlying issues, mostly from a generic standpoint, keeping in mind that there are numerous conflicts of this nature around the world. In preparation, references 1, 2 and 3 were used extensively, while references 4 and 5 also gave additional valuable perspective.

We also include extracts from a Case Study by Frank Brennan S.J. (reference 1) as Visiting Presidential Scholar, Santa Clara University. He is a professor of law in the Institute of Legal Studies at the Australian Catholic University and officer of the Order of Australia (AO) for services to Aboriginal Australians, particularly as an advocate in the areas of law, social justice and reconciliation.

APOLOGIES FOR PAST WRONGS AND GRIEVANCES
Disputes over a common history after past conflicts often overshadow the present and future relations of peoples and states for many generations. Contemporary political debates concerning conflicts in the recent as well as the more distant past are extensive in number, demonstrating that past perceptions matter in today’s politics, and that conflicts do not necessarily resolve by ending a war or signing a treaty. Negotiating an agreement can send a positive signal to the parties involved that they are willing to end the injustices and violence, but the emotional issues created can cause a danger of resuming hostilities even after coming to a negotiated settlement. Thus, in order for a conflict to be truly resolved there needs to be a lengthy process of reconciliation aimed at eradicating the emotional barriers between those involved and resuming trust between the victims and perpetrators.

But what measures can most effectively bring about reconciliation and accommodate the process of restoring trust? Justice generally demands that the perpetrators are punished, and that victims are restored to the position they were in before the injustice occurred. Often this is done either by restoring a stolen property, or, when this is impossible, victims should receive compensation equal to the value of what was unjustly taken from them, possibly accompanied by compensation for the harm resulting from the wrong. This is considered to be sufficient enough to address the moral trauma incurred by the victim and satisfy feelings of vengeance. But what if the initial perpetrators and the victims cannot be clearly identified because they no longer exist? Who should be held accountable for past injustices, what measures should be taken to correct the wrongs committed in the past, or indeed should anything be done at all?

National apologies serve as official acknowledgments of collective responsibility for historical injustices delivered by states to other states or communities. An apology is usually delivered by individuals representing the state, but having a distinctly political character is perceived to be indicative of the opinion of the collective – usually, the nation. National apologies have received a great deal of attention in a variety of academic disciplines such as law, sociology, psychology and philosophy, triggered by the large number of apologies issued lately as well as the perception that they could in a way repair the past thus contributing to settling the emotional issues brought about by historic injustice. However, have apologies become too commonplace, such that what it means to deliver or receive a national apology is likely to be vague and ambiguous? Further, are we in an “age of apology” for nations and other institutions, or is there a greater historical consciousness operating; or, are we witnessing simply a trend of a “culture of confession”, which at another level, accessible media sites and celebrity hosts bring to the forefront?

Happily, or at least optimistically, we are progressing towards ensuring emerging human rights globally and a role for morality in international affairs. In recent decades, aggrieved groups have made claims for the recognition of past or present victimization, seeking apologies as the means by which their history is officially acknowledged, and their identity reclaimed. As the distance between event and apology lengthens, the “apology moment” is made more possible as present leaders who were not personally implicated in past policies enable the separation of the personal from the political.

The collective or political apology has emerged as a rhetorical tool in international relations, national politics, truth commissions, and the self-reflective practice of a range of institutions, including churches. The stated purpose is usually reconciliation, though damage control or self-justification may also be suspected. Yet how do we make sense of what is happening, and develop an accounting of the possibilities and limits of such apologies?

There are many examples of political leaders expressing regret, remorse or apologising to the victims or their descendants for past wrongdoings. The Vatican remains the leader in the number of apologies issued by a political body, having delivered more than 300 apologies for the crimes perpetrated by the Catholic Church throughout years; Queen Elisabeth II apologised for the wrongs done to Maoris in New Zealand; British Prime Minister Tony Blair apologised for the lack of help during the potato famine in Ireland in 1840s; German Chancellor Willy Brandt in 1970 acknowledged responsibility for the Holocaust; In 1988, the US Congress apologised to Japanese Americans for their internment and discriminatory treatment during World War II. In 2008, the US Senate passed the Indian Health Care Improvement Act acknowledging "a long history of official depredations and ill-conceived policies by the United States Government regarding Indian tribes" and offering "an apology to all Native Peoples on behalf of the United States." Following a number of separate apologies by states, the US congressional apologised for slavery in June 2009; in Australia 2008, the national Parliament apologised to the Aboriginal people; in 2008 an apology was made by Canadian Prime Minister Stephen Harper to former students of Indian Residential Schools.

To the extent that representatives of institutions view apologies as a sign of strength rather than weakness, residing in a moral universal larger than the narrow interests of any one group, then collective apologies are likely to proliferate. Yet, political apologies may also reflect a particular historical moment. What are political apologies about, at root - justice, or reconciliation? Are they about collective memories, or psychological healing? Are complicated calculations of self-interest involved? Are they about meeting a need for a victimized group? How have particular apologies affected a situation? What does effectiveness look like? And do they provide previously unrecognized windows into the nature and function of the institution apologizing? Clearly, further work needs to be done when constructing, analyzing and determining the outcomes of an “apology”.

For some, national apologies are seen as empty symbolic politics, a way of winning favour without paying a real price with (practical) monetary restitution. Others perceive symbolic gestures such as apologies as an important element in acknowledging responsibility, but insist that they ought to be followed by material commitments.

In the academic literature, an apology is perceived as the central and most important element in rectifying past injustices, without which attempts to renew the relationship between the parties involved remains focused on retributive means, based on punishment and easing the feelings of vengeance. Ideally, rectification and reconciliation should be aimed towards establishing positive relations in the future, rather than settling the debts with the past and instituting punishment. Therefore attaching worth to only practical and financial means of rectification can contribute to justice but is not sufficient to eliminate the emotional barriers between the victims and the perpetrators. What is crucial for any conflict to truly be resolved is the phase of reconciliation, which morally accommodates the victims and the perpetrators, establishing new relations of trust, not tainted by past misconducts.

If closely examined, how far do national apologies go towards the “ideal”, and how much does self-interest motivate the act, with little necessary dialogue from both sides, and diminished moral meaning?

Reparative action should only be motivated by the wish to repair the implications of injustices, instead of being means of achieving a potentially favourable result: using a theoretical framework of “virtue ethics”, it expresses the agent’s moral character and acts as the starting point for further discussion.

One of the basic reasons for scepticism about national apologies, transgenerational responsibilities and reparative action in general is the objection that they misidentify the victims and the perpetrators, with the present players “standing in” those acting out and being on the receiving end of past transgressions. However, ignoring past wrongdoings simply because the perpetrators or the victims are no longer alive seems blind to the role historic debates and outcomes play in contemporary politics and life. The basic moral principles of responsibility should apply to all transgenerational searches for justice alike. In order for apologies to be taken seriously, certain guiding principles or standards to follow would enhance their effectiveness.

Until more consideration and discussion is devoted to this research, the debate around national apologies will remain contested and divided, and past discriminations and injustices will continue to hinder progressive relationships beneficial to all.

Extracts - A Case Study by Frank Brennan
In Australia 2008, "the Parliament of Australia" uttered the performative "sorry", and only after all State and Territory Parliaments, churches and other social welfare agencies had done the same. It apologised in its own name acknowledging that earlier parliaments and governments had "inflicted profound grief, suffering and loss" on persons who were their "fellow Australians." The parliament saw its apology as a first step acknowledging the past followed by a second step: "laying claim to a future that embraces all Australians." The parliament pledged itself and future parliaments to "a future based on mutual respect, mutual resolve and mutual responsibility." This apology by the elected parliament came eleven years after individual citizens had started a concerted national campaign of personal apologies for past wrongs and present ongoing consequences.

Brennan suggests the following lessons from the Australian experience:
1. A national apology must be a response to sustained requests by identifiable victims.
2. A national apology must build upon individual apologies and apologies by agencies involved in previous wrongdoing, and not substitute for them.
3. The "we" who apologise must not speak on behalf of the living who are not willing parties to the apology.
4. The "we" who apologise must not presume to speak on behalf of the deceased, applying contemporary moral standards to past behaviour which was legal and judged justifiable at the time.
5. The "we" who apologise must intend to express through their performative utterance of the word "sorry" not only sympathy and regret but also collective responsibility for the ongoing effects of past actions, which "we" now have cause to regret, offering sympathy and entitled assistance to the victims still living and their descendants who have also been affected by those past actions.
6. The "we" who apologise should identify with the collective "we" of the past, who, being the same agent in the polity, approved these past actions or who, at least, failed to counter these past actions when having a duty to act in the interests of the victims.
7. The victims and their descendants should be willing to accept the apology.
8. The "we" (binding the future collective "we") and the victims and their descendants should be prepared to commit themselves to putting the past behind them and working together for a new future.
9. The apology should be backed by a firm commitment by the "we" to make resources available to put right the ongoing adverse effects of past actions, while also leaving open the possibility of payment of compensation (reparations) in proven cases of wrongs committed on identifiable persons.

REFERENCES
1. Brennan F. Stepping Forward to Right Historical Wrongs: National Apologies - Lessons From Down Under. Markkula Center for Applied Ethics. Santa Clara University. March 2008 http://www.scu.edu/ethics/practicing/focusareas/global_ethics/apologies.html Accessed April 14, 2012.
2. Kaleja A. The Role of National Apologies in Rectifying Historical Injustices. MSc International Political Theory University of Edinburgh. August, 2010 PDF document http://www.google.ca/#hl=en&sugexp=frgbld&gs_nf=1&cp=66&gs_id=4&xhr=t&q=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&pf=p&sclient=psy-ab&site=&source=hp&oq=The+Role+of+National+Apologies+in+Rectifying+Historical+Injustices&aq=f&aqi=&aql=&gs_l=&pbx=1&bav=on.2,or.r_gc.r_pw.,cf.osb&fp=1d8e567df3a74d9a&biw=1280&bih=822 Accessed April 14, 2012.
3. Bergen JM. Reconciling Past and Present. A Review Essay on Collective Apologies.
Journal of Religion, Conflict, and Peace. Volume 2. Issue 2, Spring 2009
http://www.religionconflictpeace.org/node/52 Accessed April 14, 2012.
4. Pettigrove G. Apologies, Reparations and the Question of Inherited Guilt. Public Affairs Quarterly (2003), 17,4: 319-348. http://www.jstor.org/discover/10.2307/40441363?uid=3739400&uid=2129&uid=2&uid=70&uid=3737720&uid=4&sid=56037396173 Accessed April 14, 2012.
5. Human Rights and Equal Opportunity Commission, Bringing Them Home: The Stolen Children Report. Australian Government Publishing Service, 1997. http://www.hreoc.gov.au/social_justice/bth_report/index.html Accessed April 14, 2012.

HEALTH CARE IN CANADA – An Essay

Preamble: A public consultation on health care, called the Conversation on Health, took place during 2007 in the Canadian province of British Columbia.[1] Our firm made a written submission [2], and now we take the opportunity to transform the core of this into an overview of Canada’s health care, on the premise that this may be of global interest.

NOTE: The essay is written for the Canadian context, so we caution that Canada’s model is NOT readily translatable to most other countries. However, it may be a viable option for economically developed ones that still lack universal coverage.

We reserve the right to change our views on any aspect of this essay as new analysis may emerge to justify revision, and in this sense it may be viewed as a work in progress.

NEW NOTE January 25, 2013: Due to the popularity of this posting (based on our web traffic statistics) we wish to alert readers to a related article: White F, Nanan D. A Conversation on Health in Canada: revisiting universality and the centrality of primary health care. J Ambul Care Manage. 2009;32(2):141-149.  Full FREE access to that article has been arranged at the following site: http://www.phabc.org/modules.php?name=Contentpub&pa=showpage&pid=173

CANADIAN HEALTH CARE – An Overview
Canada’s health system enjoys wide public support. Its most valued features are: universality, portability and no direct fees for insured services, financed by government in accordance with the Canada Health Act (1984). The objective under the Act is "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."

While the Canada Health Act resonates politically, not all health modalities are equally recognized. Nor are they equal in terms of need, quality of supporting evidence, nor necessarily affordable. Choices have always have been made. Thus, even though “comprehensiveness” is one of the stated principles, in practice this particular attribute has never been a reality as it refers historically to services deemed “medically necessary” in the context of 3-4 decades ago when the provincial acts supporting universal health care were promulgated. Elements still not adequately recognized include: home care, long term care, dental care, physiotherapy and pharmaceuticals, and others. A relevant question: will universality be applied in future to services not fully financed today?
To the extent that the system delivers on equity therefore, it approaches this only for fully insured medical and hospital-based services; but where coverage is not universal, ability to pay is critical. This contrast reflects how society views health as a public good, what it considers essential, the extent of equity it seeks, and the resources it is prepared to allocate. While the Canadian experience overall has been positive, the commitment and sustainability are remain functions of social values and political will. Canada’s health care system is justifiably a source of pride, but there is still much room for improvement

Health therefore is both a complex social goal and a major enterprise in Canada, mostly now based in the public sector. While compassion and human rights lie at its base, it is also seen in terms of the social and economic benefits it provides to the entire population.

INTER & INTRA JURISDICTIONAL COMPARISONS
A systematic review of 38 studies recently confirmed that Canada’s system leads to health outcomes that are favourable overall when compared with the US private for-profit system, at less than 50% of the cost [3]. However, perhaps more relevant is WHO’s landmark study in 2000 of health systems performance in almost 200 countries, ranking the UK in 18th place, Canada at 31st, and the US (most expensive health care in the world) at 37th. Most European countries performed better than Canada, while Australia’s performance (similar socio-demographics) at 32nd place was virtually tied with Canada [4]. Several other countries also scored better than Canada eg., Singapore, Japan. In our view, rather than dismiss such comparisons (which is unfortunately a defensive reaction in some circles) Canada should study and learn from those systems which appear to be doing better, and (while staying consistent with the core principles of the Canada Health Act) be more prepared to innovate, test and evaluate new approaches. We should also show more interest in the internal comparisons being revealed from within our health and social sectors [5], specifically: why are health conditions so different for different groups within the country, and what can be done about this? The key premise here is to be guided by evidence within the social contract represented by the Canada Health Act.

When one examines overall health status of populations using objective measures, it is tempting to conclude that the health systems of countries with similar socio-economic conditions appear to vary more with regard to cost than performance, irrespective of the public-private mix. However, the type of system does appear to have a strong influence on the indicators of equity. Beyond observing the principle of universality, this is reflected in steadily improving outcomes. A new Canadian study [6] reveals that – over a 25 year period – differences between the richest and poorest quintiles in expected years of life lost amenable to medical care decreased 60% in men and 78% in women. Reductions in rates of death amenable to medical care made the largest contribution to narrowing the socioeconomic mortality disparities. Continuing disparities in mortality in causes amenable to public health suggest that public health initiatives have a potentially important but yet unrealized role in further reducing mortality disparities in Canada.

If we make the political decision that there is probably already enough money in the system, the challenge in achieving better performance necessarily must lie in improving leadership, priority-setting, decision-making and management at all levels: in particular, we must do better on health promotion, public health and preventive medicine. On the other hand, there are many in society and among the ranks of the health professions who believe that the system we have is already doing very well, and – while its underlying principles seem secure – we would adjust its design and the way it is working at our peril. Nonetheless, the existing budget is by definition aligned with the status quo, mostly a legacy of thinking of the early 1970s (when most Canadian provinces launched their particular version of “medicare”). Does it necessarily follow that this is the only formulation we are capable of, or has the time come to expand the scope of health services to more within currently underfinanced sub-sectors eg., pharmacare, dentistry?
LOOKING WHERE THE OBJECT IS LOST, NOT WHERE THE LIGHT IS BEST
When engaged in public debate about health care, as a society Canada tends to focus on the high cost items that preoccupy institutional administrators, while overlooking the powerful forces that preserve our health: healthy living environments and workplaces, primary prevention (eg., nutrition education, childhood immunization, ante-natal care, physical activity, smoking prevention), and social policies (affecting literacy, employment, crime, housing quality and community wellbeing). These are the “upstream factors”. We also become so preoccupied with acute care issues, which are crisis-prone and sometimes glamorized, forgetting not only the upstream factors, but even downstream ones (eg., long-term care, home care) whose availability determines the speed with which acute care patients may move on to more appropriate levels of care.

To the extent that health systems fail, especially with regard to addressing priority needs and the ethic of equity (universality, access, affordability), this most often results from failing to deliver on basic needs, especially for groups that lack power or recognition.

OUR SUGGESTIONS FOR THE CONTINUED STEWARDSHIP OF CANADIAN HEALTH CARE

o That federal and provincial governments continue to recognize health as a public good, recommit to the principles of universality and equity in health services delivery, and curtail private for-profit entities as an alternative in any area of core or essential services. Clearly our governments must continue to ensure that how it puts together services must be in compliance with the Canada Health Act (1984).

o The Government of Canada should be kept under scrutiny regarding the decline in its financial contributions to provincial health services, thereby contravening the Canada Health Act. The “new” federal government must be held accountable for reneging on the Kelowna Accord (investment in aboriginal peoples) and Child Care. These failures to honour prior commitments that enjoyed public support reveal a short-sighted federal political agenda that undermines important determinants of health and social equity.

o Also in the spirit of the Canada Health Act, we urge government to re-examine now what services should be core or essential, and to consider expansion of the scope of publicly financed provisions, with emphasis on the more vulnerable eg., dental provisions for children and the elderly; provisions for new parents eg., maternity leave and child care, and expand the eligibility and/or scope of pharmacare for elderly. This is particularly timely given record governmental budget surpluses in recent years.

o Health care quality and outcomes for Canadian jurisdictions generally compare favorably with those of the US. Nonetheless, the tendency of Canadians to refer to the US performance in health care and outcomes as if this is a desirable norm is misplaced. It makes more sense to learn from the experience of systems elsewhere in the world eg., western Europe, Japan, Singapore, that are better performers than the failing US model. To the extent that Canada looks to the US for systems design support or medical records contracting, this must not threaten privacy; under the current US administration even its own citizens are losing trust regarding the invasion of privacy in the name of security.

o The most critical elements of any health system needs to be public health (ie., population health provisions, including health promotion) and primary health care: to the extent that systems fail, this is often due to failure to support these components. Effort is needed to attract talented individuals to engage in these fields. The responsibility for this lies with professional education institutions, specialty bodies and professional associations, with support from relevant ministries to ensure that effective action is taken.

o There is a need for Canada to strengthen its response to the surging chronic disease burden. The international literature indicates that about half of this burden is potentially preventable through attention to modifiable behaviours eg., smoking, fitness, weight control; and about half of those who do develop these conditions can be prevented from progressing to more complicated forms through attention to secondary prevention eg., blood pressure screening; active glucose monitoring for persons with diabetes.

o When one looks at Canada’s population health internally, it is obvious that there is still a substantial amount of inequity, both regionally eg., northern regions, inner city areas, and by population group eg., First Nations. We therefore recommend that, equity must be given more prominence in the public debate and in government decision making.

References1. Conversation on Health. Government of British Columbia, Canada (2007): http://www.bcconversationonhealth.ca/EN/401/
2. Pacific Health & Development Sciences. Shaping health in BC – observations and suggestions. Submission to the B.C. Conversation on Health. http://www.bcconversationonhealth.ca/media/PacificSci_COH_Submission.pdf
3. Guyatt GH, Devereaux PJ, Lexchin J, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Med 2007;1(1):e27–36.
4. The World Health Report 2000. June 21, 2000. Geneva. http://www.who.int/whr/2000/en/index.html
5. Hertzman C, Irwin LG. It takes a child to raise a community: population-based measurement of early child development. Human Early Learning Partnership. No 1: July 2007. http://www.earlylearning.ubc.ca/
6. James PD, Wilkins R, Detsky, Tugwell, Manuel DG. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health 2007; 61:287-296. http://jech.bmj.com/cgi/content/abstract/61/4/287